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Improved Long-term Outcome of Damus-Kaye-Stansel Procedure Without Previous Pulmonary Artery Banding
Takashi Kido1, Maria-Theresa Steringer1, Janez Vodiskar1
1Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig Maximilian University, Munich, Germany.
Insights
A primary Damus-Kaye-Stansel (DKS) procedure offers better long-term survival and preserved ventricular function for single ventricle patients compared to staged palliation. This approach is recommended for favorable outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- The Damus-Kaye-Stansel (DKS) procedure is a surgical technique used in managing complex congenital heart defects.
- Patients with a functional single ventricle often require palliative or reconstructive surgeries.
- Evaluating long-term outcomes of different surgical strategies is crucial for improving patient care.
Purpose of the Study:
- To assess the long-term results of a primary DKS procedure.
- To compare outcomes of primary DKS versus staged palliation involving pulmonary artery banding.
- To identify the optimal surgical approach for single ventricle patients with potential outflow tract obstruction.
Main Methods:
- Retrospective review of medical records from 1994-2019 at the German Heart Center of Munich.
- Comparison of two groups: primary DKS procedure (n=52) and staged DKS after pulmonary artery banding (n=24).
- Analysis of survival rates, hemodynamic data, ventricular function, and valve function.
Main Results:
- Ten-year survival was significantly higher in the primary DKS group (89%) compared to the staged DKS group (68%) (P=0.04).
- The primary DKS group showed a lower pressure gradient through the systemic ventricular outflow tract before total cavopulmonary connection (P < .001).
- Reduced ventricular function and higher neoaortic regurgitation were more common in the staged DKS group (P < .001).
Conclusions:
- A primary DKS procedure is recommended for single ventricle patients with potential outflow tract obstruction.
- This approach leads to favorable long-term survival.
- It also preserves ventricular function and semilunar valve competence.
Background:
This study sought to determine long-term outcomes of a primary Damus-Kaye-Stansel (DKS) procedure in patients with a functional single ventricle and to compare the results with those of our historical control subjects who underwent pulmonary artery banding before the DKS procedure.
Methods:
The study reviewed the medical records of all patients who underwent the DKS procedure at the German Heart Center of Munich, Germany between December 1994 and December 2019.
Results:
The DKS procedure was performed as initial palliation in 52 patients (primary DKS group) and as staged palliation after pulmonary artery banding in 24 patients (staged DKS group). The median follow-up period after the DKS procedure was 8.9 years in the primary DKS group and 8.0 years in the staged DKS group. The survival rates at 10 years after the DKS procedure were 89% in the primary DKS group and 68% in the staged DKS group (log-rank P = 0.04). Before total cavopulmonary connection, the pressure gradient through the systemic ventricular outflow tract was significantly lower in the primary DKS group than in the staged DKS group (P < .001). At last follow-up echocardiography, reduced ventricular function was observed in 1 patient in the primary DKS group and in 7 patients in the staged DKS group (P < .001). The degree of neoaortic regurgitation was significantly higher in the staged DKS group than in the primary DKS group (P < .001).
Conclusions:
A primary DKS procedure in patients with a functional single ventricle and potential systemic ventricular outflow tract obstruction is recommended to obtain favorable long-term survival with preserved ventricular function and competent semilunar valve function.
